| Cordova Psychiatric Associates | |
|
993 Cordova Station Ave Cordova TN 38018-6317 | |
| (901) 737-4565 | |
| (901) 737-4312 |
| Full Name | Cordova Psychiatric Associates |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 993 Cordova Station Ave, Cordova, Tennessee |
| Authorized Official Name and Position | Mark Allen Hesselrode (OWNER) |
| Authorized Official Contact | 9017374565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cordova Psychiatric Associates 8289 Cordova Rd #106 Cordova TN 38016 Ph: (901) 737-4565 | Cordova Psychiatric Associates 993 Cordova Station Ave Cordova TN 38018-6317 Ph: (901) 737-4565 |
| NPI Number | 1386899300 |
|---|---|
| Provider Enumeration Date | 11/18/2008 |
| Last Update Date | 09/28/2021 |
| Certification Date | 09/28/2021 |
| Medicare PECOS PAC ID | 5496906562 |
|---|---|
| Medicare Enrollment ID | O20121119000524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386899300 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | APN0000007462 (Tennessee) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Richard D Sykes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942315627 PECOS PAC ID: 1759376163 Enrollment ID: I20040415001238 |
| Provider Name | Mark Hesselrode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164417127 PECOS PAC ID: 7719959154 Enrollment ID: I20040806001131 |
| Provider Name | Sandra F Mccullough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043270895 PECOS PAC ID: 9638481914 Enrollment ID: I20150629002072 |
| Provider Name | Katelyn Lee Conner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760902712 PECOS PAC ID: 2769756717 Enrollment ID: I20180109001004 |
| Provider Name | Brandi Wood Beard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295337756 PECOS PAC ID: 2961814983 Enrollment ID: I20201216002030 |
| Provider Name | Renee Mathis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952919102 PECOS PAC ID: 4486061751 Enrollment ID: I20210402000586 |
| Provider Name | Kendra Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861139081 PECOS PAC ID: 1355722430 Enrollment ID: I20220720003202 |
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